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Safe Medication Administration

  • Responsibility of the Nurse

    • As a nurse, you are responsible for every medication you administer.
    • It is crucial to become second nature in looking up medications before administration.

  • Checklist for Medication Administration

    • Rights of Medication Administration:
    • Right medication
    • Right documentation
    • Right route
    • Right time
    • Right patient
    • Right dosage
    • Importance of knowing how the medication is administered (e.g., IV vs oral).

  • Medication Classifications and Understanding

    • Understand the different classifications as medications can be used for different reasons.
    • Example: Acetaminophen (Tylenol) can be used for fever, while Motrin (Ibuprofen) can be used for pain and headaches.

  • Clinical Decision-Making

    • Always administer medication based on doctor’s order.
    • If a patient is in pain after receiving medication for a specific reason (e.g., Motrin for headache), consult the physician for new orders if patient indicates additional discomfort.

  • Medication Textbook

    • A drug book is essential as it's a vital reference for safe administration of medications.

  • Triple Check Process

    • Triple Check for Medication Administration:
    • Pull: Check the medication against the MAR (Medication Administration Record).
    • Prep: Prepare the medication and check it against the MAR again.
    • Pass: Recheck it against the MAR right before administration.
    • Purpose is to ensure the right medication is given to the right patient to prevent errors.

  • Dispensing Systems

    • Different healthcare facilities may have different dispensing systems (e.g., locked carts needing codes).

  • Six Rights of Medication Administration

    1. Right Patient: Verify identity to avoid medication errors (e.g., confusion between similar names).
    2. Right Drug: Ensure medication matches what was prescribed.
    3. Right Dose: Confirm that the dosage is accurate.
    4. Right Route: Verify how the medication should be administered (oral, IV, etc.).
    5. Right Time: Administer medication at the correct time intervals.
    6. Right Documentation: Document administration immediately to prevent double dosing and errors.

  • Additional Rights

    • Right Reason: Ensure medication is administered for the appropriate clinical indication.
    • Right to Know: Patients have the right to understand what medication they are receiving.
    • Right to Refuse: Patients can refuse medication, which must be respected.

  • Order Components for Medication Administration

    • An order must include:
    • Right patient,
    • Right drug,
    • Right dose,
    • Right route,
    • Right frequency,
    • Date and time,
    • Doctor's signature.
    • If an order is incomplete or unclear, the nurse must contact the physician for rectification.

  • Oral Medications

    • Types of Oral Medications:
    • Liquid medications
    • Pill forms
    • Ensure the patient can swallow or sip water; if not, consult for alternate routes.
    • Always supervise patients taking oral medications to ensure they ingest them.

  • Administration Techniques for Liquid Medications

    • Pour liquid medications at eye level to accurately measure the dose, aligning the bottom of the meniscus with the measurement line.

  • Buccal and Sublingual Administration

    • Buccal medications are placed in the cheek area, while sublingual medications are placed under the tongue to dissolve.

  • Topical Medications

    • When administering creams and ointments, wear gloves and check the patient's skin for irritations or lesions.

  • Nebulizer Use

    • Different nebulizers can deliver medication in spray, powder, or mist form to be inhaled.

  • Transdermal Patches

    • Rotate application sites and document date, time, and initials after placement.
    • Examples: Nicotine patches.

  • Syringe and Needle Handling

    • Maintain sterility by avoiding contact with the bevel and hub of the needle.
    • Types of syringes:
    • Luer lock and non-Luer lock syringes.
    • Insulin syringes are identified by orange caps, issued in units.
    • Distinction of syringe sizes and increments for dose accuracy (e.g., a 3 mL syringe with 0.1 mL increments).

  • Vials and Ampules Handling

    • Wipe the rubber valve on vials before drawing medication.
    • For ampules, break away from the body and utilize a covered method to ensure safety.

  • Reconstitution of Medications

    • Follow specific guidelines to accurately mix medications, ensuring thorough mixing without visible particles.

  • Needle Safety Practices

    • Never recap a contaminated needle; utilize a one-hand scoop method if necessary.

  • Medical Waste Management

    • Be familiar with different waste disposals specific for sharps, chemotherapy, and pharmaceuticals.

  • Comfort and Safety Considerations in Administration

    • Use therapeutic communication to ease patient anxiety before administration.
    • Positioning and pressure applied post-injection should be gentle; avoid massaging injection sites.

  • Intramuscular Injections

    • Common sites include deltoid (up to 1 mL), vastus lateralis (up to 5 mL), and ventrogluteal sites (up to 3 mL).

  • Z Track Method

    • For intramuscular injections, displace the skin laterally and inject to minimize discomfort.

  • Monitoring Patient Lab Values

    • Certain medications require monitoring of lab values (e.g., INR for blood thinners).

  • Insulin Administration

    • Insulin can be given via injection or insulin pens; doses checked against sliding scale based on patient’s blood sugar.
    • Importance of patient education on purpose and logistics of insulin administration.

  • Patient Allergies

    • Always verify patient allergies prior to medication administration to avoid adverse reactions.

  • Conclusion

    • Engage with practice opportunities, questions, and quizzes to reinforce learning and ensure understanding of safe medication administration practices.